Provider Demographics
NPI:1285443275
Name:OSTERLAND, KENNEDY CHRISTINE
Entity type:Individual
Prefix:
First Name:KENNEDY
Middle Name:CHRISTINE
Last Name:OSTERLAND
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5844 MARSH RD
Mailing Address - Street 2:
Mailing Address - City:CHINA
Mailing Address - State:MI
Mailing Address - Zip Code:48054-4507
Mailing Address - Country:US
Mailing Address - Phone:586-350-1789
Mailing Address - Fax:
Practice Address - Street 1:4065 E HILLS CT SE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49546-6299
Practice Address - Country:US
Practice Address - Phone:616-942-2081
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-03
Last Update Date:2025-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI7152001052235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist